Healthcare Provider Details

I. General information

NPI: 1619203668
Provider Name (Legal Business Name): MAGDALEN EDMUNDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 POTRERO AVE BLDG 80 ATTENTION: CREDENTIALING DEPT.
SAN FRANCISCO CA
94110-2859
US

IV. Provider business mailing address

995 POTRERO AVE BLDG 80 ATTENTION: CREDENTIALING DEPT.
SAN FRANCISCO CA
94110-2859
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5252
  • Fax: 415-206-8387
Mailing address:
  • Phone: 415-206-5252
  • Fax: 415-206-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA110258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: